| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $7K | — | $7K | 4.07% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES, | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | — | $4K | 2.35% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | — | $3K | 1.83% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 900 E. HAMILTON AVE. SUITE 500 CAMPBELL, CA 95008 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $163 | $2K | 8.53% |
| GA SOLUTIONS LLC3 | 311 CLOCK TOWER CMNS BREWSTER, NY 10509 | PRINCIPAL LIFE INSURANCE COMPANY | — | $916 | $916 | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $326 | $326 | 1.78% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 200 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 25 | $181K |
| Dental | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 37 | $25K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 37 | $25K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 200 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.